Latent classes of DSM-5 acute stress disorder symptoms in children after single-incident trauma: findings from an international data archive

Figures & data

Table 1. Demographic characteristics

		n (%)
Sex	Boys	1455 (63.6)
	Girls	832 (36.4)
Age (years)	5–7	160 (7.3)
	8–11	828 (37.8)
	12–14	708 (32.3)
	15–17	493 (22.5)
Country of residence	Australia	456 (19.9)
	Switzerland	161 (7.0)
	UK	441 (19.3)
	USA	1229 (53.7)
Ethnic minority in country of residence	Yes	871 (41.2)
	No	1244 (58.8)
Parent completed secondary education	Yes	934 (78.9)
	No	250 (21.1)
Trauma type	Unintentional injury	1124 (49.8)
	Acute medical event (non-injury)	113 (5.0)
	RTA requiring medical attention	784 (34.7)
	Interpersonal violence	236 (10.5)
Prior trauma history	Yes	964 (62.0)
	No	591 (38.0)

Table 2. Characteristics of included studies

PACT/R dataset number	Sample size	Type(s) of acute trauma exposure (index event)	Age range (years)	Country	Year(s)
1001	219	Injury/RTA^a	8–17	US	1999–2001
1002	90	Injury/RTA^b	5–7	US	1999–2001
1003	164	Injury/Medical/RTA/Violence^c	8–17	US	2002–2004
1004	38	Violence^d	8–18	US	1999–2000
1006	363	Injury/Medical/Violence/RTA^e	8–17	US	2007–2010
1007	88	Injury/RTA^f	8–17	US	2007–2008
1008	53	Injury/RTA^g	8–17	US	2005
1009	61	Violence^h	12–17	US	2001–2003
1010	132	Injury^i	6–16	AUS	2000–2002
1012	99	Injury^j	7–15	AUS	2003–2004
1014	49	Injury^k	7–15	AUS	2007
1020	79	Violence/RTA^l	10–17	UK	2001–2002
1021	45	RTA^m	6–11	UK	2004–2005
1022	121	Injury/Medical/Violence/RTA^n	7–17	AUS	2004–2006
1023	50	RTA^o	7–16	SUI	2004–2007
1025	91	Injury/Violence^p	12–18	US	2002–2003
1026	55	Injury/RTA^q	8–16	AUS	2013–2014
1032	111	Injury/RTA^r	7–15	SUI	2016–2018
1036	62	Injury/RTA/Violence^s	8–17	US	2012–2014
1037	218	Injury/Medical/RTA/Violence^t	8–17	UK	2010–2013
1038	99	Injury/Medical/RTA/Violence^u	6–13	UK	2014–2015

RTA = road traffic accident.

^aKassam-Adams and Winston (2004).

^bFeinberg (2004).

^cKassam-Adams (2006).

^dFein et al. (2002).

^eKassam-Adams et al. (2013).

^fKassam-Adams et al. (2011).

^gMarsac, Donlon, Winston, and Kassam-Adams (2013).

^hPailler, Kassam-Adams, Datner, and Fein (2007).

ⁱLe Brocque, Hendrikz, and Kenardy (2010).

^jKenardy, Thompson, Le Brocque, and Olsson (2008).

^kCox, Kenardy, and Hendrikz (2010).

^lMeiser-Stedman, Yule, Smith, Glucksman, and Dalgleish (2005).

^mMeiser-Stedman, Smith, Glucksman, Yule, and Dalgleish (2008).

ⁿNixon, Ellis, Nehmy, and Ball (2010).

^oZehnder, Meuli, and Landolt (2010).

^pZatzick et al. (2006).

^qAlisic et al. (2015).

^rde Haan, Tutus, Goldbeck, Rosner, and Landolt (2019).

^sMarsac et al. (2017).

^tMeiser-Stedman et al. (2017).

Hiller et al. (2018).

Table 3. Fit indices for 1–7 class solutions

Model	Loglikelihood	BIC	AIC	Entropy R^2	BLRt p-value	LMR-A p -value
1 Class	−16,972.49	34,053.27	33,972.98
2 Class	−14,895.88	30,016.07	29,849.75	0.82	<.001	<.001
3 Class	−14,588.65	29,517.64	29,265.30	0.75	<.001	<.001
4 Class	−14,538.06	29,532.49	29,194.13	0.66	<.001	0.12
5 Class	−14,493.49	29,559.37	29,134.98	0.67	<.001	0.07
6 Class	−14,459.36	29,607.13	29,096.72	0.66	<.001	0.24
7 Class	−14,429.88	29,664.20	29,067.76	0.68	<.001	0.13

BIC = Bayesian Information Criterion; AIC = Akaike Information Criterion; BLRt = Bootstrap Likelihood Ratio test; LMR-A = Lo-Mendell Rubin adjusted loglikelihood ratio test.

Table 4. Probability of ASD symptom presence for three-class solution (N = 2287)

	Low symptoms class (N = 971, 42%)		Intermediate symptoms class (N = 980, 43%)		High symptoms class (N = 336, 15%)
	Prob.	SE	Prob.	SE	Prob.	SE
Intrusive memories/thoughts	0.07	.01	0.51	.03	0.91	.02
Distressing dreams	0.02	.01	0.16	.02	0.52	.04
Flashbacks	0.02	.01	0.17	.02	0.63	.04
Distress at reminders	0.04	.01	0.44	.03	0.91	.02
Negative mood	0.06	.01	0.25	.02	0.59	.04
Altered sense of reality	0.16	.02	0.41	.03	0.73	.04
Inability to remember some parts	0.16	.02	0.30	.02	0.49	.04
Avoid memories/thoughts/feelings	0.17	.01	0.65	.03	0.89	.02
Avoid external reminders	0.04	.01	0.43	.03	0.79	.03
Sleep disturbance	0.12	.02	0.30	.02	0.78	.03
Irritable/angry	0.05	.01	0.27	.02	0.71	.03
Hypervigilance	0.11	.02	0.48	.03	0.87	.03
Concentration problems	0.06	.01	0.23	.02	0.70	.04
Exaggerated startle	0.04	.01	0.27	.02	0.69	.03

Note. Prob = probability estimate; SE = standard error.

Figure 1. Three-class solution with estimated symptom probabilities per class (n = 2287)

Table 5. Correlates of class membership

	Total sample	Class 1: low symptoms N = 971 (42%)	Class 2: intermediate symptoms n = 980 (43%)	Class 3: high symptoms n = 336 (15%)	Pairwise comparisons based on multivariate model (N = 2287)
Child gender, N (%)
Girl	832 (36.4%)	322 (33.2%)	348 (35.5%)	162 (48.2%)	1 = 2 < 3
Boy	1455 (63.6%)	649 (66.8%)	632 (64.5%)	174 (51.8%)
Age (in years), M (SD)	11.88 (3.05)	12.31 (3.01)	11.54 (3.03)	11.68 (3.03)	1 > 2 = 3
Ethnic minority, N (%)
Yes	871 (41.2%)	345 (37.9%)	390 (43.8%)	136 (43.3%)	1 = 2 = 3
No	1244 (58.8%)	566 (62.1%)	500 (56.2%)	178 (56.7%)
Parent completed secondary education, N (%)
Yes	934 (78.9%)	469 (83.3%)	363 (75.9%)	102 (71.3%)	1 > 2 = 3
No	250 (21.1%)	94 (16.7%)	115 (24.1%)	41 (28.7%)
Trauma type^a, N (%)
Unintentional injury	1124 (49.8%)	526 (54.7%)	480 (49.5%)	118 (36.2%)
Acute medical event^a (non-injury)	113 (5.0%)	56 (5.8%)	44 (4.5%)	13 (4.0%)	1 = 2 = 3
RTA requiring medical attention^a	784 (34.7%)	323 (33.6%)	329 (34.0%)	132 (40.5%)	1 = 2 < 3
Interpersonal violence^a	236 (10.5%)	57 (5.9%)	116 (12.0%)	63 (19.3%)	1 < 2 < 3
Trauma history, N (%)
Yes	964 (62.0%)	481 (63.7%)	374 (61.6%)	109 (56.6%)	1 = 2 = 3
No	591 (38.0%)	274 (36.3%)	233 (38.4%)	84 (43.5%)
					Pairwise comparisons based on univariate model (N = 2287)
Number of ASD symptoms endorsed, M (SD)	3.72 (3.29)	.90 (.89)	4.47 (1.62)	9.63 (2.05)	1 < 2 < 3
Impairment, N (%)
Yes	591 (37.8%)	146 (20.4%)	268 (43.4%)	177 (76.6%)	1 < 2 < 3
No	973 (62.2%)	569 (79.6%)	350 (56.6%)	54 (23.4%)

^aUnintentional injury is reference group. Ethnic minority in country of residence; ASD = acute stress disorder; RTA = road traffic accident.

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